title: Longitudinal urban-rural discrepancies in the US orthopaedic surgeon workforce.
abstract: BACKGROUND
  It is unclear whether the supply of orthopaedic surgeons can meet the needs of a growing and aging population. This may be especially concerning in rural areas where there are known disparities in overall healthcare provision.
  
  
  OBJECTIVE
  We therefore (1) determined urban-rural trends in the US physician and orthopaedic workforce (including the age of that workforce) from 1995 to 2010; (2) geographically mapped the physician and orthopaedic distribution; and (3) examined urban-rural changes in select nonorthopaedic musculoskeletal provider (chiropractor and podiatrist) workforces from 2000 to 2010.
  
  
  METHODS
  County-level provider data from 1995 to 2010 were obtained from the Department of Health and Human Services. This was aggregated to Hospital Referral Regions and ranked by Rural-Urban Continuum Code. Hospital Referral Region-level data were mapped to identify geographic trends. Total physician and orthopaedic surgeon workforce data were averaged across the most urban and rural regions for the study period.
  
  
  RESULTS
  There were urban-rural discrepancies in the physician and orthopaedic workforce from 1995 to 2010 with fewer orthopaedic surgeons in rural areas than urban areas (6.52 versus 8.73 per 100,000 in 2010; p=0.001). Furthermore, orthopaedic surgeons in rural areas were older than their urban counterparts, with a workforce age ratio (age>55: age<55 years) of 0.92 versus 0.65 in 2010 (p=0.024). From 2000 to 2010, the rural chiropractor and podiatrist workforces showed tremendous growth of 229.6% and 279.9%, respectively.
  
  
  CONCLUSIONS
  There were significant urban-rural orthopaedic surgeon workforce discrepancies from 1995 to 2010. Concurrent growth in chiropractor and podiatrist numbers shows significant trends in the musculoskeletal provider workforce that warrant continuing observation and analysis.
  
  
  METHODS
  Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, Yale Physicians Building, 800 Howard Avenue, 1st Floor, New Haven, CT, 06519, USA.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Fu
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Buerba
authors.forename: Jordan
authors.initials: J
authors.lastname: Gruskay
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Grauer
mesh_terms: D054625:Healthcare Disparities; D006801:Humans; D009985:Orthopedics; D010820:Physicians / Q000600:supply & distribution*; D019035:Rural Health Services; D019037:Urban Health Services; D000078329:Workforce